No abstract

A 71-year-old woman had an abdominal aortic disruption as a belted passenger in a motor vehicle accident. The diagnosis was unexpected, and the patient died during surgery. There have been 54 patients operated with this diagnosis since 1953; our patient was the fifty-fifth. This is an unusual injury, because the aorta is well protected in this position. Thoracic aortic injuries are much more common (20 times) than abdominal injuries. The causes are motor vehicle accidents, blows to the abdomen, explosions, and falls. Obstructing lesions such as thrombosis and intimal dissection are the more common presentation. False aneurysms occur occasionally. Free rupture has a very high and immediate mortality rate, and few patients arrive at the hospital alive. Diagnosis can be clinical, based on distal ischemia and neurologic abnormalities, or made with Doppler scanning, ultrasonography, computed tomography, or arteriography. Two thirds present acutely and one third subsequently months or even years after the original injury. Treatment consists of flap suture, thrombectomy, bypass grafting in more extensive injury, or extra-anatomic bypass in the face of severe contamination. Recently, endoluminal stenting has successfully been used, avoiding an abdominal operation completely.

More than 30,000 air gun injuries occur annually in the United States. While in the past these injuries were usually not serious unless an eye was injured, advances in technology have created air guns with the ability to maim and kill. A recent carotid injury with embolization of the BB is presented. Modern air rifles can produce a muzzle velocity of 1,200 feet per second, faster than many low-velocity handguns and rifles. Head, chest, and abdominal injuries have lead to permanent damage and death. Federal and state laws have not kept up and air rifles are only mentioned in the laws of 28 states, and then often only to exclude them from being termed firearms or weapons. The law should take cognizance of the fact that air guns have changed and should be governed by the same laws that apply to firearms.

The Cigarette Purchase Task (CPT) is a behavioral economic method for assessing demand for cigarettes. Growing interest in behavioral correlates of tobacco use in clinical and general populations as well as empirical efforts to inform policy has seen an increase in published articles employing the CPT. Accordingly, an examination of the published methods and procedures for obtaining these behavioral economic metrics is timely. The purpose of this investigation was to provide a review of published approaches to using the CPT. We searched specific Boolean operators (["behavioral economic" AND "purchase task"] OR ["demand" AND "cigarette"]) and identified 49 empirical articles published through the year 2018 that reported administering a CPT. Articles were coded for participant characteristics (e.g., sample size, population type, age), CPT task structure (e.g., price framing, number and sequence of prices; vignettes, contextual factors), and data analytic approach (e.g., method of generating indices of cigarette demand). Results of this review indicate no standard approach to administering the CPT and underscore the need for replicability of these behavioral economic measures for the purpose of guiding clinical and policy decisions.